@extends('layouts.backend')

@section('content')
<div class="container">
    <div class="row justify-content-md-center">
        <div class="col-md-8 align-self-center mt-5">
            <div class="panel panel-alternative panel-alternative-register panel-alternative-blank">
                <div class="panel-heading" style="height: auto;">
                    <h1 class="text-dark">Datos del cliente Persona Natural</h1>
                    <p>Todos los datos son requeridos</p>
                </div>
                <div class="panel-body">
                    <form class="form-horizontal" id="kycForm">
                        <div class="row">
                            <div class="form-group col-md-6 {{ $errors->has('type_id') ? ' has-error' : '' }}">
                                <label for="type_id" class="control-label font-weight-bold">Identificación</label>
                                <select class="form-control custom-select" name="type_id" id="type_id" >
                                    <option value="1">Cédula</option>
                                    <option value="2">Pasaporte</option>
                                    <option value="3">Licencia de conducir</option>
                                </select>
                                @if ($errors->has('type_id'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('type_id') }}</strong>
                                </span>
                                @endif
                            </div>
                            <div class="form-group col-md-6 {{ $errors->has('identification') ? ' has-error' : '' }}">
                                <label for="identification" class="control-label font-weight-bold">Número de Identidad</label>
                                <input id="identification" type="input" class="form-control" name="identification" value="{{ old('identification') }}" required>
                                @if ($errors->has('identification'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('identification') }}</strong>
                                </span>
                                @endif
                            </div>
                        </div>
                        <div class="row">
                            <div class="form-group col-md-6{{ $errors->has('issuing_state') ? ' has-error' : '' }}">
                                <label for="issuing_state" class="control-label font-weight-bold">País de emisión</label>
                                <div class="issuingState">
                                    <select class="form-control custom-select" name="issuing_state" id="issuing_state" >
                                    </select>
                                </div>
                                @if ($errors->has('issuing_state'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('issuing_state') }}</strong>
                                </span>
                                @endif
                            </div>
                            <div class="form-group col-md-6{{ $errors->has('date_issue') ? ' has-error' : '' }}">
                                <label for="date_issue" class="control-label font-weight-bold">Fecha de emisión</label>
                                <input id="date_issue" type="date" class="form-control" name="date_issue" value="{{ old('date_issue') }}" required>
                                @if ($errors->has('date_issue'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('date_issue') }}</strong>
                                </span>
                                @endif
                            </div>
                        </div>
                        <div class="row">
                            <div class="form-group col-md-6{{ $errors->has('date_expiry') ? ' has-error' : '' }}">
                                <label for="date_expiry" class="control-label font-weight-bold">Fecha de expiración</label>
                                <input id="date_expiry" type="date" class="form-control" name="date_expiry" value="{{ old('date_expiry') }}" required>
                                @if ($errors->has('date_expiry'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('date_expiry') }}</strong>
                                </span>
                                @endif
                            </div>
                            <div class="form-group col-md-6{{ $errors->has('gender') ? ' has-error' : '' }}">
                                <label for="gender" class="control-label font-weight-bold">Genero</label>
                                <select class="form-control custom-select" name="gender" id="gender" >
                                    <option value="M">Masculino</option>
                                    <option value="F">Femenino</option>
                                </select>
                                @if ($errors->has('gender'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('gender') }}</strong>
                                </span>
                                @endif
                            </div>
                        </div>
                        <div class="row">
                            <div class="form-group col-md-6{{ $errors->has('marital_status') ? ' has-error' : '' }}">
                                <label for="marital_status" class="control-label font-weight-bold">Estado Civil</label>
                                <select class="form-control custom-select" name="marital_status" id="marital_status" >
                                    <option value="1">Soltero</option>
                                    <option value="2">Casado</option>
                                    <option value="3">Divorciado</option>
                                    <option value="4">Viudo</option>
                                </select>
                                @if ($errors->has('marital_status'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('marital_status') }}</strong>
                                </span>
                                @endif
                            </div>
                            <div class="form-group col-md-6{{ $errors->has('country') ? ' has-error' : '' }}">
                                <label for="Country" class="control-label font-weight-bold">{{__('messages.country')}}</label>
                                <div class="countryinput">
                                    <select class="form-control custom-select" name="country" id="country" >
                                    </select>
                                </div>
                                @if ($errors->has('country'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('country') }}</strong>
                                </span>
                                @endif
                            </div>
                        </div>
                        <div class="row">
                            <div class="form-group col-md-6{{ $errors->has('state') ? ' has-error' : '' }}">
                                <label for="state" class="control-label font-weight-bold">{{__('messages.state')}}</label>
                                <div class="stateinput">
                                    <select class="form-control custom-select" name="state" id="state" >
                                    </select>
                                </div>
                                @if ($errors->has('state'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('state') }}</strong>
                                </span>
                                @endif
                            </div>
                            <div class="form-group col-md-6{{ $errors->has('city') ? ' has-error' : '' }}">
                                <label for="city" class="control-label font-weight-bold">{{__('messages.city')}}</label>
                                <div class="cityinput">
                                    <select class="form-control custom-select" name="city" id="city" >
                                    </select>
                                </div>
                                @if ($errors->has('state'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('state') }}</strong>
                                </span>
                                @endif
                            </div>
                        </div>
                        <div class="row">
                            <div class="form-group col-md-6{{ $errors->has('street') ? ' has-error' : '' }}">
                                <label for="street" class="control-label font-weight-bold">{{__('messages.street')}}</label>
                                <input id="street" type="input" class="form-control" name="street" value="{{ old('street') }}" required>
                                @if ($errors->has('street'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('street') }}</strong>
                                </span>
                                @endif
                            </div>
                            <div class="form-group col-md-6{{ $errors->has('house') ? ' has-error' : '' }}">
                                <label for="house" class="control-label font-weight-bold">{{__('messages.house')}} # / APT</label>
                                <input id="house" type="input" class="form-control" name="house" required>
                                @if ($errors->has('house'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('house') }}</strong>
                                </span>
                                @endif
                            </div>
                        </div>
                        <div class="row">
                            <div class="form-group col-md-6{{ $errors->has('postal') ? ' has-error' : '' }}">
                                <label for="postal" class="control-label font-weight-bold">{{__('messages.postal')}}</label>
                                <input id="postal" type="text" class="form-control" name="postal" value="{{ old('postal') }}" required>
                                @if ($errors->has('postal'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('postal') }}</strong>
                                </span>
                                @endif
                            </div>
                            <div class="form-group col-md-6{{ $errors->has('phone') ? ' has-error' : '' }}">
                                <label for="phone" class="control-label font-weight-bold">{{__('messages.phone')}}</label>
                                <div class="phoneinput">
                                    <input type="text" name="phone" id="phone" class="form-control input-medium bfh-phone" data-format="+1 (ddd) ddd-dddd">
                                </div>
                                @if ($errors->has('phone'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('phone') }}</strong>
                                </span>
                                @endif
                            </div>
                        </div>
                        <div class="row">
                            <div class="form-group col-md-6{{ $errors->has('bornDate') ? ' has-error' : '' }}">
                                <label for="bornDate" class="control-label font-weight-bold">{{__('messages.birthdate')}}</label>
                                <input id="bornDate" type="date" class="form-control" name="bornDate" value="{{ old('bornDate') }}" required>
                                @if ($errors->has('bornDate'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('bornDate') }}</strong>
                                </span>
                                @endif
                            </div>
                            <div class="form-group col-md-6{{ $errors->has('bornCity') ? ' has-error' : '' }}">
                                <label for="bornCity" class="control-label font-weight-bold">{{__('messages.born')}}</label>
                                <div class="borninput">
                                    <select class="form-control custom-select" name="bornCity" id="bornCity" >
                                    </select>
                                </div>
                                @if ($errors->has('bornCity'))
                                <span class="help-block">
                                    <strong>{{ $errors->first('bornCity') }}</strong>
                                </span>
                                @endif
                            </div>
                        </div>
                        <div class="text-center">
                            <a class="btn btn-alternative" href="{{ route('kyc-verification') }}">Regresar</a>
                            <button type="button" class="btn btn-alternative" id="continue" name="button">{{__('system.continue')}}</button>
                        </div>
                    </form>
                </div>
            </div>
        </div>
    </div>
</div>

@include('modals.confirmModal')
@include('modals.messageModal')
@endsection